Passion project: Medical student investigates rare surgical complication that changed her grandfather’s life
M3 Alex Erling’s grandfather lost his leg to a post-operative infection. She wants to understand why and prevent it from happening to others.
Alex Erling, a third-year medical student, was inspired by her grandfather's rare medical condition to investigate the connection between cellulitis and joint infection. (Photo by Arda Athman, School of Medicine)
Alan Lane wasn’t surprised when his granddaughter, Alex Erling, was accepted into the School of Medicine. He knew she would get in, he said, because Erling “is the kind of person who will get whatever she puts her mind to.”
What he couldn't have anticipated, however, was Erling using that determination to research a medical condition that had affected him personally. In 2021, he underwent the amputation of his right leg due to complications following a routine knee replacement. Two years later, his granddaughter took on a research project to understand why it happened.
“I think when you’re able to connect what you’re learning or researching to a person, it sticks better and motivates you to learn about these issues,” Erling said. “It reminds you why you’re in medical school.”
A long journey to a rare diagnosis
Recurrent cellulitis, a chronic version of the common bacterial skin infection, has been a lifelong struggle for Lane. Anything from a bug bite to too much time in the sun could cause a flare-up, which antibiotics effectively cleared over the years. In 2015, a lifetime of playing rugby caught up with Lane, necessitating a total right knee replacement.
Complications began almost immediately after the operation. Over the next six years, Lane’s cellulitis flare-ups clustered around the surgical site, and doctors eventually diagnosed Lane with periprosthetic joint infection (PJI), a rare condition in which the replacement prosthesis itself becomes infected. Even after multiple visits with infectious disease specialists, IV antibiotic infusions and a second total knee replacement, the pain and infections persisted.
The toll of his medical situation was evident. Erling, who was in college at the time, said her once vibrant grandfather became emotionally withdrawn, and her grandmother became his full-time caregiver. As more and more treatment options failed to relieve Lane’s pain, doctors began discussing the possibility of amputating above the knee.
“When it got really bad, you could see how much the pain had drained him,” Erling said. “He used to always sing and joke, but he was just so exhausted from the whole experience. It was really hard to watch.”
In 2021, Lane chose to undergo an amputation of his right leg above the knee. The relief was immediate, and despite his new disability, Erling said he returned to the warm and jovial grandpa she knew before.
“I’m really happy he and my grandmother got through it as well as they did, and he’s doing great nowadays,” Erling said. “He got really unlucky after his surgery, and I wanted to find out why that is to prevent it from happening to other people.”
Alex Erling (left) and her grandfather, Alan Lane, have always had a close relationship. (Submitted photo) Finding answers
Erling knew she wanted to conduct research during her first year of medical school, and when she was brainstorming topics, her grandfather’s ordeal “was always in my head.” She eventually reached out to Gregory Golladay, M.D., a professor in the Department of Orthopaedic Surgery, with the idea of studying the relationship between cellulitis and PJI. That same afternoon, she said, Golladay jumped on a call to discuss her pitch and schedule a meeting with other researchers in the department.
After Erling secured funding through the Dean’s Summer Research Fellowship, Golladay put her in contact with researchers at George Washington University and Johns Hopkins University. Together, they combed through a database of relevant patient records and analyzed the relationship between PJI and cellulitis. Their findings, which are currently undergoing revisions for publication, showed that even one past cellulitis diagnosis heightened the risk of developing a PJI.
Erling said the next step of her research is to see if extending the waiting period before surgery, currently a year without diagnosis, for patients with a past instance of cellulitis, could lessen the risk of PJI.
“Joint infection really isn’t all that common in the grand scheme of things,” Erling said. “But this population is at a greater risk and when it does happen, you want to make sure you’re addressing it correctly.”
Exploring diverse interests
Erling views research as an opportunity to explore different aspects of medicine, even if it doesn’t directly relate to her future career. She is interested in pursuing pediatrics as a specialty but is grateful for the flexibility to conduct research related to an issue that is personal to her.
“You're busy enough as a medical student, so I think if you’re going to devote time to something else, it should be something you’re passionate about,” Erling said. “Taking the time to find something that excites you is worth it.”
Lane said he feels “honored” that his granddaughter is investigating a condition that affected him personally and finding better outcomes for others.
“Nothing like that had ever happened in our family, so it was very thoughtful and considerate of her to want to learn more about it,” Lane said. “She always gives 100% and wants to be the best she can be.”
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